Invasive candidiasis in the ICU--pathogenesis and management strategy

How should new and old antifungals be used in the management of invasive candidiasis in ICU patients? A pathogenesis-based management strategy for invasive candidiasis is outlined. Colonisation of the catheterised bladder by Candida species should be eliminated to prevent invasion from the urinary tract. Invasion from the peritoneum (in the patient with a perforated bowel) should be treated promptly to prevent local vascular invasion. Empirical therapy is recommended for treatment of suspected disseminated candidiasis, 'pulmonary' candidiasis and vascular-access candidiasis. Dose and duration of therapy are decided according to clinically determined patient/disease categories and modified according to information from laboratory results. Short-term low-dose regimens are suitable for peritoneal candidiasis that is recognised early, and for vascular-access candidiasis, provided the source-catheter can be removed.